Provider Demographics
NPI:1356560585
Name:NICHOLAS C. DAVIS, D.D.S., APC
Entity type:Organization
Organization Name:NICHOLAS C. DAVIS, D.D.S., APC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:NICHOLAS
Authorized Official - Middle Name:CHRIS
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:949-644-9211
Mailing Address - Street 1:2503 EASTBLUFF DR
Mailing Address - Street 2:SUITE 102
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92660-3505
Mailing Address - Country:US
Mailing Address - Phone:949-644-9211
Mailing Address - Fax:949-644-1156
Practice Address - Street 1:2503 EASTBLUFF DR
Practice Address - Street 2:SUITE 102
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-3505
Practice Address - Country:US
Practice Address - Phone:949-644-9211
Practice Address - Fax:949-644-1156
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA237811223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty